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Thromb Haemost 2019; 119(03): 490-495
DOI: 10.1055/s-0039-1677745
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Incidence of Cancer after a Second Unprovoked Venous Thromboembolic Event

Shéhérazade Rézig
1   EA 3878 (GETBO), Brest University Hospital, Brest University, Brest, France
,
Raphael Le Mao
1   EA 3878 (GETBO), Brest University Hospital, Brest University, Brest, France
2   Department of Chest Diseases and Internal Medicine, Hôpital de la Cavale Blanche, Brest Cedex, France
,
Francis Couturaud
1   EA 3878 (GETBO), Brest University Hospital, Brest University, Brest, France
2   Department of Chest Diseases and Internal Medicine, Hôpital de la Cavale Blanche, Brest Cedex, France
3   CIC INSERM 1412, Hôpital de la Cavale Blanche, Brest Cedex, France
,
Karine Lacut
1   EA 3878 (GETBO), Brest University Hospital, Brest University, Brest, France
2   Department of Chest Diseases and Internal Medicine, Hôpital de la Cavale Blanche, Brest Cedex, France
,
Aurélien Delluc
1   EA 3878 (GETBO), Brest University Hospital, Brest University, Brest, France
4   Division of Hematology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
› Author Affiliations Funding The study was supported by grants from INSERM (Contrat de Recherche Stratégique 2001, CRES No. 4CR05G), from Région Bretagne (Programme 1044–04013235 no. 1440) and Programme Hospitalier de Recherche Clinique 2000. The Centre Hospitalier Régional et Universitaire de Brest promoted the study. The funders of this study had no role in the design or conduct of the study; in the collection, analysis or interpretation of the data; or in the preparation, review or approval of the manuscript.
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Publication History

20 July 2018

09 December 2018

Publication Date:
27 January 2019 (online)

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Abstract

Patients with two unprovoked venous thromboembolism (VTE) events could be at high risk for cancer diagnosis and may therefore benefit from extended cancer screening strategies. However, accurate data on the incidence of cancer in this population is lacking. In a prospective cohort study, we followed-up with all patients who experienced two unprovoked symptomatic VTE events that occurred in less than 2 years apart. We estimated the 1-year incidence rate of cancer following the second unprovoked VTE event using the Kaplan–Meier method. Potential predictors for cancer diagnosis were assessed using a Cox proportional hazard regression model. Between May 2000 and December 2013, we included 197 patients with two episodes of symptomatic unprovoked VTE that occurred in less than 2 years apart. Their mean age was 66.2 ± 16.3 years, and 122 (51.8%) were male. Seventeen patients were diagnosed with cancer during the year following the second episode of unprovoked VTE, corresponding to a cumulative incidence rate of 9.19% (95% confidence interval [CI]: 5.81–14.37). The 1-year cumulative incidence rate of cancer was 35.88% (95% CI: 19.75–59.25) in patients with VTE recurrence on anticoagulation, 5.51% (95% CI: 2.9–10.32) among patients with a second episode of unprovoked VTE occurring after stopping anticoagulation and 1.15% (95% CI: 0.16–7.88) when time elapsed between the first and recurrent VTE was > 1 year. Our study suggests that the incidence of cancer in patients with a second episode of unprovoked VTE that occurs off anticoagulation, or > 1 year after the first event, is similar to that of patients with a first unprovoked VTE event.

Keywords

unprovoked venous thromboembolism - occult cancer - symptomatic VTE events
 

  • References

  • 1 Carrier M, Le Gal G, Wells PS, Fergusson D, Ramsay T, Rodger MA. Systematic review: the Trousseau syndrome revisited: should we screen extensively for cancer in patients with venous thromboembolism?. Ann Intern Med 2008; 149 (05) 323-333
    CrossrefPubMedSearch in Google Scholar
  • 2 Delluc A, Ianotto JC, Tromeur C. , et al. Real-world incidence of cancer following a first unprovoked venous thrombosis: results from the EPIGETBO study. Thromb Res 2018; 164: 79-84
    CrossrefPubMedSearch in Google Scholar
  • 3 van Es N, Le Gal G, Otten HM. , et al. Screening for occult cancer in patients with unprovoked venous thromboembolism: a systematic review and meta-analysis of individual patient data. Ann Intern Med 2017; 167 (06) 410-417
    CrossrefPubMedSearch in Google Scholar
  • 4 Ahmed Z, Mohyuddin Z. Deep vein thrombosis as a predictor of cancer. Angiology 1996; 47 (03) 261-265
    CrossrefPubMedSearch in Google Scholar
  • 5 Prandoni P, Lensing AW, Büller HR. , et al. Deep-vein thrombosis and the incidence of subsequent symptomatic cancer. N Engl J Med 1992; 327 (16) 1128-1133
    CrossrefPubMedSearch in Google Scholar
  • 6 PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). JAMA 1990; 263 (20) 2753-2759
    CrossrefPubMedSearch in Google Scholar
  • 7 Ageno W, Squizzato A, Wells PS, Büller HR, Johnson G. The diagnosis of symptomatic recurrent pulmonary embolism and deep vein thrombosis: guidance from the SSC of the ISTH. J Thromb Haemost 2013; 11 (08) 1597-1602
    CrossrefPubMedSearch in Google Scholar
  • 8 Sørensen HT, Mellemkjaer L, Steffensen FH, Olsen JH, Nielsen GL. The risk of a diagnosis of cancer after primary deep venous thrombosis or pulmonary embolism. N Engl J Med 1998; 338 (17) 1169-1173
    CrossrefPubMedSearch in Google Scholar
  • 9 White RH, Chew HK, Zhou H. , et al. Incidence of venous thromboembolism in the year before the diagnosis of cancer in 528,693 adults. Arch Intern Med 2005; 165 (15) 1782-1787
    CrossrefPubMedSearch in Google Scholar
  • 10 Carrier M, Lazo-Langner A, Shivakumar S. , et al; SOME Investigators. Screening for occult cancer in unprovoked venous thromboembolism. N Engl J Med 2015; 373 (08) 697-704
    CrossrefPubMedSearch in Google Scholar
  • 11 Piccioli A, Lensing AW, Prins MH. , et al; SOMIT Investigators Group. Extensive screening for occult malignant disease in idiopathic venous thromboembolism: a prospective randomized clinical trial. J Thromb Haemost 2004; 2 (06) 884-889
    CrossrefPubMedSearch in Google Scholar
  • 12 Robin P, Le Roux PY, Planquette B. , et al; MVTEP study group. Limited screening with versus without (18)F-fluorodeoxyglucose PET/CT for occult malignancy in unprovoked venous thromboembolism: an open-label randomised controlled trial. Lancet Oncol 2016; 17 (02) 193-199
    CrossrefPubMedSearch in Google Scholar
  • 13 Vaidyanathan S, Walsh J, Cliffe H. , et al. Utility of additional abdominopelvic CT in detecting occult cancer in patients with unprovoked venous thromboembolism. Clin Radiol 2016; 71 (06) 501-506
    CrossrefPubMedSearch in Google Scholar
  • 14 Prandoni P, Lensing AWA, Piccioli A. , et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 2002; 100 (10) 3484-3488
    CrossrefPubMedSearch in Google Scholar
  • 15 Laporte S, Tardy B, Quenet S. , et al; PREPIC Study Group. The location of deep-vein thrombosis as a predictive factor for recurrence and cancer discovery after proximal deep-vein thrombosis. Haematologica 2003; 88 (03) ELT08
    PubMedSearch in Google Scholar
  • 16 Rance A, Emmerich J, Guedj C, Fiessinger JN. Occult cancer in patients with bilateral deep-vein thrombosis. Lancet 1997; 350 (9089): 1448-1449
    PubMedSearch in Google Scholar
  • 17 Trujillo-Santos J, Prandoni P, Rivron-Guillot K. , et al; RIETE Investigators. Clinical outcome in patients with venous thromboembolism and hidden cancer: findings from the RIETE Registry. J Thromb Haemost 2008; 6 (02) 251-255
    CrossrefPubMedSearch in Google Scholar